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1003158114 NPI number — GWENDOLYN LUCILLE WILKENING RPH, PHARMD

NPI Number: 1003158114
Health Care Provider/Practitioner: GWENDOLYN LUCILLE WILKENING RPH, PHARMD

Information about “1003158114” NPI (GWENDOLYN LUCILLE WILKENING RPH, PHARMD) exists in 1003158114 in HTML format HTML  |  1003158114 in plain Text format TXT  |  1003158114 in PDF (Portable Document Format) PDF  |  1003158114 in an XML format XML  formats.

NPI Number : 1003158114 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003158114",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILKENING",
    "FirstName": "GWENDOLYN",
    "MiddleName": "LUCILLE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "RPH, PHARMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WILKENING",
    "OtherFirstName": "LUCY",
    "OtherMiddleName": null,
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "PHARMD",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "1311 E CENTRAL DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MERIDIAN",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83642-7991",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-373-1734",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1311 E CENTRAL DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MERIDIAN",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83642-7991",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-373-1734",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/27/2013",
    "LastUpdateDate": "01/30/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "52823",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1835P1300X",
          "TaxonomyName": "Psychiatric Pharmacist",
          "LicenseNumber": "P8846",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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